Health Leadership Task Force Administrative Simplification Project

1. Health Leadership Task ForceAdministrative Simplification Project Oregon Healthcare Financial Management Association Kah-Nee-Ta July 22, 2010 Paul Krissel, MSOD, project lead

2. The Health Leadership Task Force • Commissioned by the business community in the summer 2008 • Goal—Develop solutions and actions to keep health care costs and premium increases closer to the CPI • Sponsors: Legacy, Kaiser, ODS, OHSU, PacificSource, Providence, Regence

3. Oregon Health Leadership Council • Nonprofit corporation, spring 2010 • Board: the former HLTF sponsors • Members: 7 physician representatives 9 hospital and health system reps 11 Health plan reps Oregon Health Authority ex-officio

4. How work is being accomplished • HLC membership leaders to review and support recommendations • Four work groups with 120+ members -- Value Based Benefits -- Evidence Based Best Practice -- Reimbursement & Payment Reform -- Administration Simplification

5. Accomplishments to Date • Completion of a value-based benefit design for the large group market, 5 payers introducing benefit plans in 2010 • Implementing an initiative in the management of high cost imaging • Developed a new payment proposal for the medical home, 2 year pilot being initiated • Administrative Simplification…..today’s topic

6. Administrative simplification structure • Three work groups – over 100 participants Claims Eligibility Have been combined Credentialing Work completed

7. Administrative Simplification Executive Committee • Senior level staff appointed by HLC • Plan implementation of administrative simplification projects • Recommend future projects • Participate in State of Oregon administrative simplification work group • Measure success

8. Claims/Eligibility: Accomplishments to date: • Recommended single source authentication sign on to payer sites by providers – HLC is implementing through One Health Port • Target roll out for November 2010 (to be confirmed) • Executive Committee established subcommittee to plan roll out

9. Claims/Eligibility: Accomplishments to date: • Recommended 75 payer web site best practices • Providers evaluating sites and providing feedback to payers • Metrics developed to measure success • Baseline measures March 2010 • Next round of measures Sep 2010

10. Claims/Eligibility: Next steps • State of Oregon Admin Sim work group recommended working on electronic transactions • Executive Committee tasked with adapting Minnesota practice manual to Oregon • Executive Committee sets up calendar and plan through 2010 to complete

11. Credentialing: Identified major headaches Credentialing in Oregon has many components which are duplicative and confusing!

12. Credentialing: Steps taken • Created a matrix listing credentialing requirements of Health plans, Hospitals, including sources such as TJC, NCQA and the Oregon Medical Board • Identified the highest standard for each of 23 required components

13. Credentialing: Steps taken • Recommended that there be a single solution in Oregon to provide centralized data collection and verification • Created a list of essential criteria and critical elements that any credentialing solution should be measured against • Researched a range of options • Presented research to HLTF

14. Credentialing: steps taken • HLTF selected Medversant as preferred vendor to implement credentialing solution • Executive Committee tasked with vetting Medversant • Co-chairs of Exec Committee met with members of Credentialing work group to flesh out questions to ask about Medversant capabilities

15. Credentialing: next steps • Medversant responded to RFI with additional questions from Oregon and provided copy of Washington state RFP response (June 2010) • Executive Committee establishes vetting process and subcommittee • HLC agrees to continue vetting process before making final decision later this year

16. Your questions and input • Discussion